Head and neck cancer in Canada: trends 1992 to 2007

Objectives:
The objective of this study was to investigate the changes in the epidemiology (incidence, age at diagnosis, and survival) of head and neck cancers (HNCs) in Canada in the past decade.

Study Design:
Analysis of a national cancer data registry.

Setting:
All Canadian hospital institutions treating head and neck cancer.

Subjects and Methods.
Using Canadian Cancer Registry data (1992-2007), the authors categorized HNCs into 3 groups according to their possible association with human papillomavirus (HPV): oropharynx (highly associated), oral cavity (moderate association), and “other” (hypopharynx, larynx, and nasopharynx), which are not HPV related. They calculated age-adjusted incidence, median age at diagnosis, and survival for each category.

Results:
Oropharynx tumors increased in incidence over the study time period (annual percent change: 1.50% men, 0.8% women), whereas oral cavity tumors decreased (2.10% men, 0.4% women), as did other HNCs (decreased by 3.0% for men and 1.9% for women). The median age at diagnosis for oropharynx cancer decreased by an average of 0.23 years/y. There was no change for oral cavity tumors but an increase for other HNCs of 0.12 years/y. Survival for patients with oropharynx cancer increased by 1.5%/y but was significant for men only. Survival for patients with oral cavity and other HNCs also increased in men only by 0.9%/y and 0.25%/y, respectively.

Conclusion:
Oropharynx cancer, which is highly correlated with HPV infection, is increasing in incidence in Canada, with a decreasing age at diagnosis and an improvement in survival. This could have implications for screening strategies and treatment for oropharyngeal cancers in Canada.

Authors’ affiliations:
1 Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Canada
2 Department of Economics, University of New Brunswick, New Brunswick, Canada
3 Department of Otolaryngology–Head and Neck Surgery, University of Ottawa, Ottawa, Canada